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June 21, 2013

House VA Subcommittee Holds Hearing

On Wednesday, June 19, the House Veterans’ Affairs Subcommittee on Oversight and Investigations held a hearing aimed at examining three pieces of legislation which address specific issues which have come to light as a result of Congressional oversight and investigations.

The first bill was H.R. 1490, the Veterans’ Privacy Act, was introduced by the Chairman of the Full Committee Jeff Miller (FL). The bill would direct the Secretary of Veterans Affairs (VA) to prescribe regulations to ensure that, in the absence of informed consent by the patient or their legal representative, any visual recording can only be conducted under limited circumstances, such as under court order.

The second measure, H.R. 1792, entitled the Infectious Disease Reporting Act, was introduced by subcommittee Chairman Mike Coffman (CO). This legislation would require VA facilities to comply with state infectious disease reporting requirements. Once reported to a state, this data will be reported to the Centers for Disease Control and Prevention and used to monitor public health. Each state faces its own unique challenges regarding infectious diseases and the Infectious Disease Reporting Act takes this into account.

The final bill was H.R. 1804, the Foreign Travel Accountability Act, was introduced by Rep. Tim Huelskamp (KS), a member of the subcommittee. This bill would require the VA Secretary to submit to Congress semiannual reports on foreign travel. The reports would include, among other things, the purpose of each trip, the destination, and the total cost to the department.

Reps. Miller and Huelskamp comprised the first panel, and offered testimony in support of their respective pieces of legislation.

The second panel consisted of Dr. Robert L. Jesse, Principal Deputy Under Secretary for Health of the Veterans Health Administration (VHA), who delivered VA’s positions on the bills. Pertaining to H.R. 1490, Dr. Jesse stated VA supports the overall intent of the bill, but recommends a clarification of the definition of “visual recording” given that “the ‘transmission of images’ could encompass still photographs or images, such as x-rays that are then digitized or scanned, as well as cine images that are now routine in catheterization laboratories and Magnetic Resonance Imaging (MRI), ” and furthermore, “as written, H.R. 1490 would allow a physician or psychologist to conduct a medical imaging procedure, such as an X-ray, Computed Tomography (CT) scan, MRI scan, or ultrasound on a patient without the patient’s consent if the physician or psychologist deemed the procedure to be medically necessary.”

As to H.R. 1792, Dr. Jesse stated VA does not support because they “would like to discuss with the Committee ideas to provide more standardization and consistency in its practices to fulfill the aims of the bill, which we believe can be achieved without new mandates in legislation that raise legal complications, as well as create administrative burdens by requiring compliance with many different State laws.”

Finally, as to H.R. 1804, Dr. Jesse stated “VA has no objection to providing Congress with useful information for its oversight responsibilities, but we recommend the bill be amended so the data required by the semiannual reports is consistent with the data available from the E-Gov Travel Service (ETS) system, which is currently FedTraveler.com.” Additionally, he recommended “the bill be amended to exclude any employee foreign travel where a non-Federal source reimburses the Government for all costs.”

Given a lack of resolutions addressing these specific issues, The American Legion did not submit testimony for this hearing, and consequently has no stated position on these pieces of legislation.

Senate Appropriations Committee Approves MilCon-VA Spending Bill

On June 20 Legislative staff attended the Senate Appropriations Committee hearing for the full committee mark up of the fiscal year (FY) 2014 Military Construction, Veterans Affairs (VA), and Related Agencies appropriations bill. The bill provides total funding of $158.8 billion for FY 2014. The bill provides $74.4 billion in discretionary funding and $84.5 billion in mandatory funding. The bill includes $55.6 billion in FY 2015 advance appropriations for veterans’ medical services. The discretionary funding is $2.5 billion above the FY 2013 level for discretionary funding. The committee approved the bill by a vote of 23-6 and it will be reported to the full Senate for its consideration.

Bill Summary

The bill provides funding for the construction of mission critical and quality of life facilities for military personnel and their families around the world, including schools, hospitals, child care centers and family housing and funding for veterans medical care and benefits and for VA facilities throughout the country. The Related Agencies funded in the bill include Arlington National Cemetery, The American Battle Monuments Commission, the Court of Appeals for Veterans Claims, and the Armed Forces Retirement Homes.

The backlog of veterans’ compensation claims for service-related disabilities has soared to record levels over recent years. VA reports 816,839 pending claims as of June 10, 2013, of which 66% have been pending for more than 125 days and are considered to be backlog. In addition to fully funding the President’s budget request for claims processing operations, the bill includes a 10-Point Action Plan to give the VA additional tools to address the backlog and for VA training, oversight, and accountability. The 10-Point Action Plan:

ØProvides $20 million above the budget request to upgrade computer hardware, such as servers, in VA Regional Offices to handle the advanced program requirements of the Veterans Benefits Management Program (VBMS). VBMS, which is a paperless claims system, is scheduled to be installed in all Regional Offices (ROs) by the end of this month.

ØProvides an additional $10 million for targeted overtime and training for claims processors, as needed, to increase production and help eliminate the claims backlog.

ØDirects VA to increase training of claims processors to achieve expedited production and to ensure quality and accuracy to reduce claims appeals. Additionally, training programs are to be accompanied by regular testing and monitoring of poorly performing ROs to identify and remediate performance problems.

ØDirects VA to provide Quality Review Teams and spot audits at ROs to assess the performance of the claims processing operations and flag any management or operational weaknesses.

ØDirects VA to create Centers of Excellence at selected ROs for certain types of complex claims, such as claims for PTSD or TBI. With the VBMS paperless claims system, these centers could use their expertise to field claims from across the nation.

ØDirects VA to have the data management capability to receive all Department of Defense (DOD) health records in an electronic format by the end of calendar year 2013. DOD is implementing a program to have all service treatment records digitized and sent electronically to VA by the end of 2014. DOD must accelerate this effort to achieve full electronic transmission of records by the end of 2013 and VA must be prepared to accept them.

ØRequires VA to provide monthly reports to the House and Senate Committees on Appropriations on performance measures for each RO, including the number of backlogged claims, the average number of days to complete a claim, and error rates.

ØRequires VA to submit quarterly reports that include the number of claims personnel in each RO, corrective action taken to remedy any problems at poorly performing offices, training programs undertaken by ROs, and Quality Review Team audits performed during the quarter.

ØDirects VA Inspector General in coordination with DOD Inspector General to examine the processes and procedures involved in the transmission of medical and personnel records from DOD to VA to identify any problem areas and provide recommendations for improvements.

ØProvides an additional $12.9 million for the Board of Veterans Appeals to hire additional personnel to expedite the processing of appeals. The VA estimates that in 2014, the Board’s inventory of appeals will reach 46,860 with an average processing time of 625 days.

Military Construction and Family Housing

The bill provides $10.7 billion for military construction and family housing, $66.5 million above the FY 2013 level (including supplement funding).

Highlights

Active Component Military Construction:$7.7 billion to fund military construction projects worldwide, including operational, training, and research facilities, barracks, schools, hospitals, and clinics. The recommendation is $526 million above FY 2013.

Reserve Component Military Construction:$693.3 million to fund readiness centers, training facilities, and related construction for training and administration. This is $352 million below the FY 2013.

Family Housing: $1.5 billion for family housing construction and privatization projects, $122.5 million below FY 2013.

Base Realignment and Closure (BRAC):$451.4 million for the DOD Base Closure Fund. As requested by the President, the bill consolidates the 1990 and 2005 BRAC accounts into one Base Closure Fund. Funding is equal to the request.

Energy Conservation Investment Program (ECIP): $150 million for projects to improve energy efficiency and reduce greenhouse gas production on military installations.

Department of Veterans Affairs

The bill provides $147.9 billion; the total includes $84.5 billion for mandatory programs, and $11.5 billion above FY 2013. For discretionary funding, the bill provides $63.4 billion (this figure includes $54.5 billion in previously appropriated advances for veterans medical care), $31 million below the request and $2.2 billion above FY 2013. The bill also includes $55.6 billion in advance appropriations for FY 2015 VA medical care. The FY 2014 budget request included $157.5 million in additional funding to supplement the FY 2014 advance appropriation provided in FY 2013. The VA based the additional request on updates to VA medical care projections for FY 2014.

Highlights

Rural Health:Building on the Rural Health Initiative launched to close gaps in VA service in rural and remote areas, the bill provides $250 million for medical care, including telehealth and mobile clinics, for veterans in rural and highly rural areas, including Native American populations.

Homeless Veterans Programs:$6.2 billion for health care and support services for homeless veterans. This includes $1.4 billion in direct programs to assist homeless veterans, including $278 million for the HUD-VASH program and $250 million for the Homeless Grant Per Diem Program.

Iraq and Afghanistan Veterans:$4.1 billion to meet the health care needs of veterans who have served in Iraq and Afghanistan, $493 million increase over FY 2013. VA estimates the number of OEF/OIF veterans in its health care system will reach 674,754 in 2014. This funding includes medical treatment associated with combat-related injuries, including Traumatic Brain Injury (TBI) and Post-Traumatic Stress Disorder (PTSD).

Women Veterans Programs:$4.9 billion to provide healthcare for women veterans, including $422 million in gender-specific health care to meet the unique needs of female veterans.

Sexual Trauma Victims:The Committee noted the preponderance of evidence suggesting that PTSD is a frequent result of sexual trauma among military personnel and veterans. Because it is often difficult to identify specific stressors resulting in PTSD, VA in 2010 relaxed the evidentiary standards for combat veterans with PTSD. The Committee now urges VA to take similar action regarding PTSD resulting from sexual trauma.

Long Term Care: $7.6 billion for long term care for aging veterans as well as severely wounded combat veterans from the wars in Iraq and Afghanistan. The funding includes institutional and home based care programs. The bill provides $85 million for grants for the construction of State extended care facilities.

Information Technology (IT):$3.7 billion to support VA’s IT needs, $20 million over the request. Funding includes $251.9 million for the integrated electronic health record and $119.4 million for the VBMS paperless claims systems. In order to minimize potential performance problems, the Committee included an additional $20 million above the request for VA to upgrade existing hardware at ROs.

Office of Inspector General (IG):$121.4 million, $5 million over the President’s request and $6.6 million over FY 2013. The recommendation includes additional resources for increased audits and for the IG to collaborate with DOD’s Office of Inspector General in examining the processes and procedures involved in the transmission of medical and personnel records from DOD to VA and to identify any problem areas and provide recommendations for improvements.

Board of Veterans Appeals:$88.3 million, an increase of $12.9 million over the budget request. The justification accompanying the budget request projects that the Board’s average time to resolve a disability claim on appeal will be 625 days in FY 2014. VA also projects the appeals backlog to grow to 48,860 claims in 2014. The funding increase is to provide additional personnel to assist in reducing the wait time and backlog.

Related Agencies Highlights

American Battle Monuments Commission (ABMC):$77.3 million, $5 million over the request and $1.3 million above FY 2013, to support the operations and activities of the ABMC. The additional funding is to address urgent maintenance and repair requirements at America’s World War I and World War II cemeteries overseas.

Arlington National Cemetery (ANC): $70.8 million for operations, $25 million above the request and $93.4 million below FY 2013. The FY 2013 bill included $100.2 million in a separate construction account for the Millennium Project gravesite expansion at ANC. Additional construction funding is not required in FY 2014; therefore no funding has been provided for construction. However, the bill includes an additional $25 million for operational, maintenance, and repair projects at ANC that the Administration has proposed to fund through the Army Operation and Maintenance account.

Armed Forces Retirement Home:$67.8 million for operations, maintenance, and the capital program. This is $2 million above FY 2013.

LEGISLATIVE DIVISION ACTIONS

Update on Flag Amendment Bill

On May 22, House Joint Resolution (H.J. Res.) 47 was introduced by Rep. Spencer Bachus (AL). This legislation is a proposed constitutional amendment to protect the American flag from physical desecration. Its text states simply: “The Congress shall have power to prohibit the physical desecration of the flag of the United States.” The measure now has 11 cosponsors.

The next task is finding additional cosponsors for these measures. Please contact your representative and senators, and ask them to become cosponsors of the flag amendment in their respective chambers. [Resolution 272-2012]